MEDICARE: EASTSIDE PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1558290312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	400 E PINE ST
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-5401
Country	:	US
Telephone Number	:	573-686-7238
Fax Number	:	573-686-7239

Provider Business Practice Location Address
First Line	:	400 E PINE ST
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-5401
Country	:	US
Telephone Number	:	573-686-7238
Fax Number	:	573-686-7239

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEPHEN K ROWLAND
Credential	:	PIC, RPH
Telephone Number	:	573-686-7238

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “EASTSIDE PHARMACY, INC. ” Practice Location

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